HPB

Question 1

Complications of gallstones?

Answer 1

gallbladder:
biliary colic
cholecystitis
mucocele
empyema
gangrenous
perforation
gallbladder malignancy
Mirizzi’s syndrome

CBD:
cholangitis
pancreatitis

gut:
gallstone ileus
Bouveret syndrome

Question 2

What is cholelithiasis?

Answer 2

presence of gallstones

Question 3

What is choledocholithiasis?

Answer 3

gallstones obstructing the bile duct

Question 4

RFs for gallstones?

Answer 4

fair
female
fat
forty
fertile

(high oestrogen state)

Question 5

Why does biliary colic occur?

Answer 5

when fat enters the digestive system it causes cholecystokinin release from the duodenum
this causes the gallbladder to contract which causes the symptoms of biliary colic

Question 6

US findings in gallstone disease?

Answer 6

gallstones in the gallbladder (hyperechoic with acoustic shadow)
gallstones in duct
bile duct dilatation
thickened wall
sludge
fluid around the gallbladder

Question 7

What can be performed during an ECRP?

Answer 7

sphincterotomy of sphincter of Oddi if dysfunctional
clear stones from the ducts
insert stents
take biopsies

Question 8

Complications of ERCP?

Answer 8

excessive bleeding
pancreatitis
cholangitis

Question 9

Scar associated with open cholecystectomy?

Answer 9

Kocher incision
right subcostal

rare these days because laparoscopic sx preferred

Question 10

Complications of cholecystectomy?

Answer 10

bile leak
stones left in the bile duct
strictures
post-cholecystectomy syndrome

Question 11

What is post-cholecystectomy syndrome?

Answer 11

diarrhoea
indigestion
epigastric or RUQ pain
nausea
intolerance of fatty foods
flatulence

improve by themselves with time

Question 12

Types of cholecystitis?

Answer 12

calculous (95%)
acalculous

Question 13

Causes of calculous cholecystitis?

Answer 13

inflammation of the gallbladder caused by blockage of the neck of the gallbladder or the cystic duct by gallstones

Question 14

Causes of acalculous cholecystitis?

Answer 14

build-up of pressure in the gallbladder due to long periods of fasting or TPN resulting in the gallbladder not contracting

Question 15

Signs of acute cholecystitis on US?

Answer 15

thickened gallbladder wall
stones or sludge in the gallbladder
fluid surrounding the gallbladder

Question 16

Mx of acute cholecystitis?

Answer 16

nil by mouth
IV fluids
IV Abx (ceftriaxone + metronidazole)
laparoscopic cholecystectomy

Question 17

What is biliary colic?

Answer 17

temporary impaction of gallstones in Hartmann’s pouch or the cystic duct

Question 18

What is gallstone ileus?

Answer 18

when a gallstone erodes into the small bowel wall causing a cholecysto-duodenal fistula and travels through resulting in a small bowel obstruction

Question 19

What is Bouveret’s syndrome?

Answer 19

when a gallstone erodes into the duodenum causing a cholecysto-duodenal fistula and lodges there, resulting in a gastric outlet obstruction

Question 20

What is Mirizzi’s syndrome?

Answer 20

a large stone in the cystic duct or Hartman’s pouch compresses the adjacent common hepatic duct

causes jaundice

Question 21

What is Rigler’s triad?

Answer 21

pneumobilia
ectopic calcified gallstone, usually in RIF
SBO

indicative of gallstone ileus